COVID-19 changes the Global Fund strategy development process

Contents

1. NEWS

The Global Fund Board held its 43rd Board meeting virtually, via video conference link, on 14-15 May 2020. This article gives an overview of the main decisions made by the Global Fund at the meeting and by electronic voting prior to the meeting. The Board meeting was shorter than usual and included a focus on the ongoing measures taken or planned for the COVID-19 response, as well as a first exchange on the Global Fund’s next strategy, and the upcoming Inspector General selection process.

2. NEWS

The Global Fund Board discusses the process of development of the strategy post-2022. The Board approved the suggestion to postpone the partnership forums to the first quarter of 2021 in the hopes that in-person meetings could take place then. Virtual consultations of stakeholders will commence after this Board meeting.

3. NEWS

At the Global Fund’s 43rd Board meeting, the Global Fund Executive Director Peter Sands delivered his fourth report to the Board. He highlighted the influence of the COVID-19 crisis on the Global Fund grant implementation and the Global Fund response.

5. NEWS

The Inspector General Mouhamadou Diagne, in his annual report to the Global Fund’s 43rd Board Meeting, commended the Global Fund for its significant programmatic impact and improvements in the overall control of the environment and risk management processes. However, the Inspector General called for increased attention to gaps in HIV prevention, data quality challenges, defaults on domestic commitments for health, weak grant implementation arrangements and a dynamic fraud landscape. He also highlighted the disruptive effect of COVID-19 on the OIG 2020 work plan.

6. NEWS

The Global Fund reported slow progress in the implementation of agreed management actions. Unfortunately, the number of open and overdue agreed management actions rose in 2019, after an all-time low number in 2017 and 2018. COVID-19 is partly to blame as the Global Fund prioritizes critical activities such as grantmaking, continuity planning and the COVID-19 response.

7. NEWS

The Global Fund is on track to meet most of its key performance indicators for 2017–2019, according to the end-2019 Strategic Performance Report presented to the Board on 14-15 May. The organization is generally performing well on alignment to country needs, the mobilization and utilization of resources, and implementation of its domestic co-financing policy. However, the Global Fund is underperforming on reducing the number of new infections, on absorption of funds, and on the coverage of the health management information systems. Also, it is underperforming on programs for key population and human rights in middle-income countries, and the availability and affordability of health technologies.

8. NEWS

The outgoing Inspector General reflected on his experiences and results at the organization. He highlighted the role of the OIG in helping to improve the quality of risk management processes, controls, and governance in the Global Fund. He also spoke about his biggest challenges, including the lack of “a strong culture of learning and accountability” in the organization.

9. NEWS

The sixth annual report on Community, Rights and Gender to the Global Fund Board was finalized before the Global Fund’s latest set of COVID-19 related measures and guidance notes were published. This report, presented to the Board’s 43rd meeting, asks for the Board’s input regarding COVID-19, and presents a snapshot of what the Fund has achieved in the areas of human rights, community-, and gender-related barriers to access. One highlighted issue is the need for a stronger differentiation between community-based and community-led responses to issues relating to key populations.

2. NEWS

Author:

Djesika Amendah

15 May 2020

The Board approves virtual consultation of constituencies

The Board approved the timeline and some changes to the process of development of its new strategy to take the COVID-19 impact on the world into account. The Board will approve the strategy in November 2021. The strategy development process will include collecting input virtually, which is being done for the first time. The partnership forums, which are in-person meetings to collect input from different stakeholders, are postponed for the first quarter of 2021 in the hopes that travel and meetings can occur then. The Global Fund strategy is a roadmap that indicates the main path of future investment.

Information for this article comes from the Global Fund Strategy Development (GF/B43/05) presented to the Board.

Proposed timeline to develop the next strategy

The Global Fund raises funds for a three-year cycle known as replenishment. The current strategy runs till end 2022 and the next replenishment that is scheduled for Fall 2022 determines the important dates for the development of the strategy post-2022. The Global Fund Board should approve the next strategy at the end of 2021. Using the strategy, the Secretariat will develop an investment case to be launched at the beginning of 2022. The Global Fund partnership (e.g., all the stakeholders) will use that investment case for the next replenishment.

Figure 1: Timeline for the development of the strategy post-2022:

Source: Global Fund Strategy Development Board Document GF/B43/05

Timing and process of development of the new post-2022 strategy

The Global Fund Strategy Committee (SC), which oversees the Global Fund strategy development, recommended commencing consultations virtually on strategy development, beginning after this 43rd Board meeting. There are five stages in the development process. The first is the “Process stage,” where the Strategy Committee defines the process. This stage occurred in the last two Strategy Committee meetings in October 2019 and March 2020. During the second stage, “the big picture” stage, the Global Fund will launch the strategy development website to collect information, inputs, e-consultations, and updates on strategy development. This stage will occur throughout 2020.

Then comes the “focused topics stage,” which used to entail in-person “partnership forums.” Those were broad consultative meetings with different constituencies, like technical partners (e.g., the World Health Organization, Stop TB partnership), representatives of implementing countries in Latin America, Africa, Asia. Those partnership forums used to take place two years before the Board adopts the final strategy. The COVID-19 pandemic makes such in-person partnership forums impossible now. The suggestion is to push them to the first quarter of 2021, while conducting input virtually in 2020. The fourth stage is called the “Framework stage,” where the Strategy Committee and Board review the outcomes of the Partnership Forums to determine the focus and objectives of the next strategy. The Strategy Framework is currently scheduled for approval in the Board meeting of May 2021. Finally, at the “Narrative stage,” the Secretariat develops a narrative for the strategy. The final document will be approved in November 2021.

Existing challenges related to HIV, TB and malaria remain

The existing challenges concerning HIV, Tuberculosis, and malaria remain; COVID-19 further complicates most of those challenges. Some of them are specific to the three diseases, like the need to scale up HIV prevention services, to finding and successfully treating missing TB cases, to scaling up effective vector control for malaria. Other challenges are related to the need to strengthen the resilience and sustainability of health and community systems that provide services and the need to address risks and barriers to these objectives.

Undoubtedly, the COVID-19 will impact Global Health programs and the Global Fund’s next strategy.

The next strategy should learn from the strengths and weaknesses of the current strategy

The document presented by the Secretariat gave an example of some strengths and weaknesses that should inform the next strategy. For instance, some strengths of the 2017-2022 strategy are a differentiated approach to sustainability, transition, and co-financing as well as on Challenging Operating Environments (COEs); identification of focus on HIV transmission amongst adolescent girls and young women; and elevation of the importance of Resilient and Sustainable Systems for Health, human rights, gender, and domestic financing in the Global Fund’s work.

Among the weaknesses of this strategy is the lack of clarity on the specific role of the Global Fund’s in building Resilient and Sustainable Systems for Health.

A strategy in a post-COVID-19 world

Constituencies provided comments on the importance of the strategy and its development. (Aidspan has an agreement which grants access to constituency statements provided that the source is not revealed). Some constituencies mentioned the negative economic impact of the COVID-19 pandemic on different categories of countries. Some donor countries might not be willing or able to give to the Global Fund; some recipient countries who transitioned out of the Global Fund’s support might be eligible again; other implementing countries may not be able to fulfill their co-financing commitment.

Some constituencies mentioned the challenges of developing a strategy during this COVID-19 pandemic. Most constituencies expressed their preferences on the process: given that large in-person gatherings may not be possible, the importance of ensuring an inclusive process was emphasized.

Many constituencies also indicated what they would like to see in a new strategy: the same four pillars but with some nuances. These include the strengthening of health and community systems that leads to universal health care; availability of data disaggregated by age, gender and key-population status; and the protection of key and vulnerable populations including adolescents, migrants, and displaced persons. All constituencies recognized the importance of securing human rights and helping to break barriers to accessing services.

A strategy is vital as it defines the agenda for years to come, but its implementation is even more vital.